Article
Clinical and ultrasonographical follow-up after early removal of distal radius volar plates positioned distal to the watershed line
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Authors
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Pieter-Bastiaan De Keyzer
- UZ Brussel, Jette, Belgium
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Chul Ki Goorens
- RZ Tienen, Tienen, Belgium
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Jean Goubau
- AZ Sint-Jan Brugge, UZ Brussel, Jette, Belgium
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Volar plating is accepted as standard treatment for distal radius fractures. Marginal fracture types may require plate positioning distal to the watershed line or volar rim precontoured plates to obtain stable anatomical fixation. Hardware distal to the watershed line is associated with increased flexor tendon pathology, with the flexor pollicis longus tendon (FPL) most at risk. We've performed early plate removal after bony consolidation to prevent these complications. Our purpose is to evaluate the procedure relevance of early hardware removal of plates distal to the watershed line was evaluated.
Methods: 20 patients, treated between 2013 and 2017, with plate positioning grade 1 or 2 according to Soong classification were included. Assessment was performed with mobility and grip strength measurements, function scoring with Quickdash, patient satisfaction questionnaire and ultrasonographical measurements of the distance of FPL to the volar rim and pronator quadratus (PQ) diameter.
Results and Conclusions: 8 cases had Soong grade 1 prominence, 12 were grade 2. Standard volar plate was used in 12 cases, volar rim plate in 8 cases. Anatomical reduction and bony consolidation were achieved in all cases. Mean time from placement to removal was 10,8 months. Mean time from removal to assessment was 2,9 years. Mean flexion and extension was respectively 87% and 90% compared to the contralateral side, ulnar and radial deviation 90% and 88%. Pro- and supination was symmetrical. Mean grip strength was 95% compared to the opposite side. Mean Quickdash score was 21,5. 85% of patients described their result as good to excellent with sense of improved mobility and decreased flexor tendon friction. 80% would undergo the intervention again. No refracture occurred. 1 patient suffered CRPS. After plate removal, the distance between FPL and volar rim increased from direct contact between tendon and bony prominence with plate in place, but was significantly lower in neutral (p=0,013) position and in full flexion (p=0,046) compared to the opposite side. PQ diameter showed no significant difference compared to the opposite side.
We conclude that early hardware removal for prominent plates results in high patient satisfaction, with a partial normalization of the flexor tendon positioning in reference to the distal radius on ultrasound.
